Comics and Medicine Course Helps Medical Students Communicate

AAMC Reporter May 2013

—By Sarah Hawkins, special to the Reporter

Tell me your story. This is something we say to one another nearly every day. Stories are one of the best ways to share information and make meaningful connections. They also are an essential part of medical education.

Now there is a novel way for medical students to share their stories: graphic medicine. A relatively new field that uses comics in medical education and patient care, graphic medicine is now part of the curricula at several medical schools, including Penn State College of Medicine.

“Doctors need to tell stories, and love to tell stories,” said Michael Green, M.D., a professor in the departments of Humanities and Internal Medicine at Penn State. “Comics are a very effective way to communicate stories.”

Green, whose background is in bioethics, began using comics for medical education five years ago in his course, Graphic Storytelling and Medical Narratives.

Green’s own graphic narrative, Missed It, recently was published in the Annals of Internal Medicine. This is the first time a medical journal has published a comic.

The number of comics devoted to medical themes is growing, and includes graphic narratives on illnesses such as breast and lung cancer. These comics often bring to light the impact an illness has on patients, their families, and care teams.

“When I first came across these comics, I thought they would help teach medical students about doctor-patient communication, how to have greater empathy, and how to manage different illnesses and patient experiences,” Green said.

“Comics can be used for anything, including personal stories, teaching, and patient stories,” he continued. “You can use comics to tell serious stories.”

Graphic medicine course a good fit for Penn State

Penn State is a pioneer in using humanities to teach medical students. Each fourth-year student is required to take a humanities elective, and Graphic Storytelling and Medical Narratives is one option.

“The first time I taught this class, I asked my students why they signed up. I hoped people would say they loved comics, graphic novels, or arts,” Green said. “Most students took it because it fit into their schedule.”

Now they are registering based on recommendations from other students. Trey Banbury, a fourth-year medical student at Penn State who took Green’s course, said he was surprised when a comic helped him understand what mania looks and feels like for psychiatric patients.

“The graphic novels we were asked to read were simply incredible,” he said. “There are many things that cannot be said, but have to be shown.”

Students in Green’s class are required to do two things: read graphic novels and talk about them, and create their own graphic narrative. “What I help them do is take a story from their med school experience and turn it into a comic,” Green said.

Expert designers and artists are brought in to help students craft their comics. Like many in the course, Banbury had no prior experience in drawing. His comic, Perspective, shows how med students struggle with the stressors of medical school.

“As simple as my drawings are, I am proud of my comic because I never thought I would be able to create something like it,” Banbury said. “I would recommend this class a thousand times over to anyone in medicine.”

Comics help medical students share experiences

In most comics, images are manipulated and text is altered to help convey emotions and actions. In her comic, My Dream Vacation, Jessica Walrath, a fourth-year student at Penn State, depicts how many students struggle to decide which specialty to pursue in their residency.

Her comic illustrates the angst many students feel by relaying a dream she had before starting her emergency medicine rotation. “In my comic, I’m on an airplane flying to a much-needed vacation,” Walrath said. “Just as I’m about to take a nap, there’s a call over the loudspeaker asking if there’s a doctor on board.”

While she is initially conflicted over whether to raise her hand since she’s “just a third-year medical student,” in her dream, Walrath comes to the aid of a child in respiratory distress. After speaking with the child’s mother, she realizes he is having an allergic reaction. There’s an epi-pen on board, but this treatment doesn’t help his breathing. So Walrath opens a surgical airway.

“Just as I’m ready to make the incision in my dream, I wake up in my apartment with my emergency medicine textbook open to the page on how to perform an emergency cricothyroidotomy,” Walrath said, describing the end of her comic. “It was all just a dream, and I’m ready to start my rotation in emergency medicine.”

What’s next for comics and medicine

Each year, Green organizes the International Conference on Comics and Medicine. The fourth conference will be in Brighton, England, this July.

Now that the Annals of Internal Medicine has published a comic, Green and others hope more medical journals will follow suit. “Journals provide a venue for doctors to share stories,” Green said. “Why not use that space for a comic to tell an important story?”

When prospective medical students interview at Penn State, they walk past a hallway filled with large prints of comics drawn by medical students. “They’re entranced by the comics,” Green said. “I’m told it’s popular among med school candidates, and it’s unique.”

In the classroom, graphic medicine provides a unique way for professors and students to learn from one another. “One-way teaching, where we assume that students come with empty heads for us to fill, comprises much of medical school,” Green said. “This class has taught me that method is, in part, backwards.”

When students share their experiences in class, everyone benefits. “We should design medical education so that we all learn from each other to improve patient care,” Green said.

Walrath said taking Graphic Storytelling and Medical Narratives has given her a better appreciation for how patients experience illnesses, and how they interact with health care providers. “For me, comics are a great way to reflect on my medical school experience and share it with others,” she said. “I truly believe using comics will make me a better doctor.”

"Comics can be used for anything, including personal stories, teaching, and patient stories.”

—Michael Green, M.D.

One of the electives for fourth-year medical students at Penn State is "Graphic Storytelling and Medical Narratives." Pictured above is a graphic narrative by fourth-year student Trey Banbury

Detail from a graphic narrative by Penn State College of Medicine fourth-year student Jessica Walrath

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